黄色肉芽肿性膀胱炎的临床与病理特点分析

Clinical and pathologic features of xanthogranulomatous cystitis

目的 探讨黄色肉芽肿性膀胱炎（XC）的临床及病理学特点.方法 XC患者3例.男1例,女2例.年龄37（39,24,50）岁.3例均有反复发作的膀胱刺激征,2例有下腹部疼痛.查体仅1例发现下腹部肿块.2例尿瘤细胞学检查未见瘤细胞,另1例未查.B超、CT示位于膀胱顶部的占位性病变.CT示肿瘤内可见坏死及不均匀强化影像.术前诊断：膀胱肿瘤2例,脐尿管肿瘤1例.2例行膀胱部分切除术,1例行脐尿管癌根治术. 结果 3例术后均经病理证实为XC.病理特点：XC含有大量黄瘤细胞（泡沫细胞）--实质为含有脂质的巨噬细胞,伴有多核巨细胞、淋巴细胞、浆细胞浸润.术后随访12～36个月,平均28个月,患者无明显尿频、尿急等症状,B超或CT检查未见肿物复发.结论 XC临床罕见,不易与其他膀胱疾病鉴别,诊断依赖于病理组织学,同时应警惕其合并肿瘤存在的可能.治疗以手术为主.

Objective To review the clinical and pathologic features of xanthogranulomatous cystitis （XC）. Methods The clinical and pathologic data of 3 patients （2 females and 1 male, mean age, 37.3 year, age range, 24-50 year） with XC were reported in combination with review of the relevant literature. All 3 cases had recurrences cystitis-like symptoms, 2 cases had lower abdominal pain.1 case found low abdominal palpable mass during physical examination. Ultra sonography and CT revealed solid mass at the dome of the bladder. Partial cystectomy was performed on 2 patients, the rest 1 was case treated as urachal carcinoma.Results Postoperative pathology confirmed XC. Pathological features were as follows： xanthoma cells （lipidladenmacrophages）, multinucleated giant cells and cholesterol clefts. With 12-36 （mean 28） months follow-up, there was no recurrence and cystitis-like symptoms on these patients. Conclusions XC is a rare disease. XC is usually identified by pathology. The presence of a concomitant neoplasm should be considered when the diagnosis of XC is made.Surgical resection could be a curative treatment.